Hip Knees Shoulders

Patient/Consumer Information

Conditions & Procedures

The hip is a ball-and-socket joint, where the head of the femur articulates with the cuplike acetabulum of the pelvic bone. The acetabulum fits tightly around the ball, however the ball is usually held in the socket by very powerful ligaments that create a complete 'blanket' around the joint (joint capsule). This arrangement allows a large amount of motion required for daily activities such as, walking, squatting and stair-climbing.

The capsule has a delicate lining (the synovium). The head of the femur and the hip socket is covered with a layer of smooth cartilage (articular cartilage), which is quite a soft, white substance. This cartilage cushions the joint and allows the bones to move on each other with minimum friction.

Conditions Affecting the Hip Joint

Childhood Hip Disorders
Developmental Dysplasia of the Hip (clicky hips or dislocating hips)

Developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip, in which the femur is not held firmly in the socket. In some cases, the ligaments of the hip joint may be loose and stretched. The degree of looseness or instability varies in DDH and it can be detected in an x-ray. DDH is much easier to cure if it is realised at an earlier stage, otherwise the treatment becomes more complicated and uncertain.

Perthes' Disease

Perthes' Disease occurs in the femoral head - this is the rounded top of the femur. Something happens to the small blood vessels, which supply blood to the femoral head. Thus, parts of the femoral head lose their blood supply. This consequents in the softening of the particular affected areas of the femur. The bone can fracture, break up and become distorted due to the fragility of the bone, however the severity of the condition can vary.

Slipped Upper Femoral Epiphyses (SUFE)

In childhood, there are growth plates - epiphyses at the junction between the head and neck of the femur and also at the lower end of the bone. In later childhood, for some unknown reason, the head of the femur may slip up and down as ice-cream partially sliding off a cone.

Adult Conditions

Trauma - Fractures & Fracture Dislocations

This can be the result of high energy injuries, such as motor vehicle accidents, sports related injuries in the young and simple falls in the elderly with osteoporotic bones.

Inflammotary Arthritis

Inflammatory arthritis is arthritis that causes significant inflammation of the joints. Rheumatoid arthritis is the most common type of inflammatory arthritis. Other types of inflammatory arthritis are psoriatric arthritis, ankylosing spondylitis and Reiter’s syndrome (reactive arthritis).

Avascular Necrosis of the Femoral Head (AVN)

Avascular necrosis of the femoral head is an increasingly common cause of musculoskeletal disability as well as a major diagnostic and therapeutic challenge. Although, initially patients experience no symptoms, AVN usually progresses to joint destruction, requiring total hip replacement.

AVN is characterized by areas of dead trabecular bone and marrow extending to involve the subchondral plate. The anterolateral aspect of the femoral head, the principal weightbearing region, typically is involved, but no region of the femoral head is necessarily spared. In the adult, the involved segment usually never fully revascularizes and, once detected radiographically, collapse of the femoral head usually occurs later.

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It is caused by the breakdown of cartilage (the tought elastic material that protects the ends of bones). Hence, as the cartilage breaks down, there is less protection over the underlying bone, creating friction and thus, consequenting in pain.

Other Conditions Around the Hip

Bursitis

Bursae (singular: bursa) are fluid-filled sacs that cushion areas of friction between tendon and bone or skin. Generally people have 160 bursae in their bodies, however the number varies. Bursae are lined with synovial cells, which release a fluid rich in collagen and proteins. This fluid serves as a lubricant when parts of the body move. When this fluid becomes affected by bacteria or irritated due to too much movement, the painful condition, Bursitis is developed.

Referred Pain From the Back

Referred pain is commonly found in the lower back, which radiates to the buttocks, groin and thighs. The type of pain and severity differs from person to person.

Arthritis of the Hip

Arthritis is loss of articular cartilage. Hence, there is no cushioning effect on the bones and the underlying bone bears greater stress as a reult. It looses its elasticity and becomes more stiff. Any of the above mentioned conditions may result in arthritis of the hip.

All conditions affecting the hip joint can present as premature arthritis. Some symptoms may include a bit of discomfort and stiffness in your groin, buttock, or thigh when you wake up. The pain intensifies when you are active and settles when you rest.

Knee Joint

The knee is a joint, which essentially, has three parts. These include the thigh bone (femur), the shin bone (tibia) and the kneecap (patella). The femur meets the tibia forming the main joint. This joint has an inner (medial) and outer (lateral) compartment. The patella joins the femur to create the third joint.

The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint, as well as crossing within the joints. These ligaments provide stability and strength for the joint.

There is also a meniscus between the femur and tibia, which gives cushioning, so the bones can move with mimimum friction. There are also air sacs, called bursae, surrounding the joint which act as gliding surfaces.

Below the patella, there is a large tendon (patellar tendon) which joins onto the front of the tibia in addition to large blood vessels passing through the area behind the knee. The knee also rotates slightly under the guidance of specific muscles in the thigh.

Conditions Affecting the Knee Joint
Bursitis

Anterior knee pain commonly affects teenagers. Girls are affected more often than boys. It is usually the result of maltracking of the patella in the femoral trochlea. There is usually an underlying anatomical abnormality, such as a shallow femoral trochlea and/or horizontal lateral facet of the patella with or without a very vertical or no medial facet.

Arthritis of the Knee
Shoulder Joint

The shoulder joint is a ball-and-socket joint. It primarily has three joints - the shoulder blade (scapula), the collarbone (clavicle) and the upper arm (humerous). The head of the humerous rests in a shallow socket in the shoulder blade called the glenoid. Typically, the humeral head is much larger than the socket and a soft fibrous tissue rim (labrum) surrounds the socket to assist in stabilising the joint. The rim deepens the socket by up to 50%, thus giving the humeral head a better fit in the socket.

Stiff Shoulder - Home exercise program

Stiff shoulder are usually uncomfortable, even if the degree of stiffness is not great. That's the unfortunate aspect. The positive aspect is that most stiff shoulders can be managed successfully by a simple exercise regime conducted by the patient at home.

It is basically a procedure of gently and gradually getting the shoulder moving again. This regime is the safest of all treatments for frozen shoulders. Although months of these specific exercises may be required, persistence is almost always rewarded. Even if arthritis is present, this program may help preserve and even improve the shoulder's range and comfort. Prior to beginning these exercises, you should consult your physician.

There are two components to the home program for stiff shoulders. The first is a series of stretching exercies and the second relates to regular participation in a fitness program.

Your opposite arm is a great therapist for your stiff shoulder. Your 'therapist arm' is always available to apply a gentle stretch in any direction of tightness. Each of these gentle stretches needs to be held up to a count of 100.

If other directions of stiffness are identified, they can be stretched with a similar approach. An important principle of the stretching exercise is to allow your muscle to relax so that the stretch can be applied to the soft tissues without muscle interference. Tissues of a tight shoulder do not like to be stretched suddenly, roughly or with a lot of force. Thus, the strategy is to apply a gentle stretch so that at most minimal soreness results. Any soreness should go away within 15 minutes after you stop the exercises.

The great thing about this exercise is that you are in control. You can adjust the vigor of the stretching to do what is most easily tolerated by your shoulder. The exercise program is 'portable' and can be performed in your home, car, office, bus, airplane or wherever you happen to be. This is important, because consistency in this exercise regime pays off. If pain results from this program, do not stop or alter the frequency of your exercise sessions, just reduce the vigor of the stretches so that they become comfortable.

1. Forward Elevation - lying
2. Forward Elevation - sitting
3. External Elevation - standing and lying
4. Cross Body Stretch - cross body

Information

Facts

• Musculoskeletal disorders cost the United States $215 billion yearly.
There were almost 56 million physician visits for musculoskeletal injuries in 2003, accounting for 56 percent of all visits for injury.
• More than 8 million people were hospitalized in 2003 for musculoskeletal conditions.
• Musculoskeletal procedures were performed on approximately 6.5 million people in 1996, including 3.6 million people who had outpatient procedures and 2.9 million people who had in-patient procedures. In 2003, almost 3.3 million people had musculoskeletal procedures performed on an in-patient basis.
• Arthritis is the leading chronic condition reported by the elderly.
• Back or spine injuries are the most prevalent musculoskeletal impairments.
• Knee Problems: Approximately 19 million visits were made to physicians' offices due to knee problems in 2003.
• Shoulder Problems: Almost 14 million visits were made to physicians' offices due to shoulder problems in 2003.

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